Medical Residency Process

Everything you’ve heard about your medical residency is true. Residency training will be the most challenging time of your medical career. For recent medical school graduates, medical residency is an abrupt shift from being a student one day to a practicing physician the next. For International Medical Graduates, medical residency presents the challenges of “repeating” your training while simultaneously adapting to the specific procedures and culture of U.S. teaching hospitals. In any case, it pays to do your residency research.

Navigating the Residency Match process can be a little confusing and very frustrating. We created this area to help you prepare for the Match and start your residency research with confidence.

Researching Residency Programs

Now that most medical residency applications are processed electronically through ERAS (the Electronic Residency Application Service), candidates have to do their own residency research on specific programs.

If you are currently attending a US medical school, meet with your clinical or residency advisor to identify programs that match your career goals and strengths. If you are applying as an Independent Applicant, get the Graduate Medical Education Directory (also known as the Green Book) or access the online FRIEDA database. Both of these are available through the American Medical Association and contain program information by specialty and by location.

Start your research with the NRMP Match results books, which list programs that did not fill. Keep in mind that the better a program, the more likely it will fill its positions through the Residency Match process. Programs that offer competitive training, high fellowship acceptance rates, high specialty board exam passing rates, strong and receptive leadership, and a balance between education and service tend to fill their positions each year.

The Residency Match Process

Each year, programs submit the number of positions that they wish to have filled through the National Residency Matching Program (NRMP). ERAS receives documents from the applicant, the ECFMG, U.S. medical schools, and the USMLE. These documents are formatted, scanned, and assembled into individual applicant packets, and are electronically sent to as many programs as the applicant chooses. Programs evaluate applications and determine which applicants they want to interview during November, December, and January.

The Rank Order List

After interviews, the programs list applicants by preference (rank order list). Simultaneously, applicants submit a list of programs in rank order. Applicants are electronically matched to the highest-ranked program on their list that has offered a position to that applicant.

Students who have not matched are usually informed the day before match results are announced. Students and their schools begin “the scramble” to find unfilled residency training positions—a madcap competition for the best remaining residency spots.

Create an Effective Residency Personal Statement

While no personal statement is going to guarantee an interview or ensure that you match, a poorly written one can definitely hurt your chances. So how do you develop a statement that reads well and clearly communicates your specialty choice, your qualifications, and your plans for the future?

The Anatomy of the Residency Personal Statement

The personal statement should not be a biography. Rather, it should consist of three basic parts. First, the statement should explain what it is about your specialty that most appeals to you. Second, it should present information from your background that provides evidence that you have acquired the skills, traits and abilities to succeed in that specialty. The third section should communicate any particular aspects you are looking for in a residency program, a brief description of your goals, a summation line that lists the strengths you would bring to that program if accepted, and finally, a thank you for their consideration of your credentials.

Any writer will tell you that their work goes through a number of drafts and many revisions before they feel it truly communicates what they want it to say. You can then work with it, eliminating what doesn’t need to be there and choosing the right words to highlight the messages that you most want to communicate. The final version should be no more than a single page that clearly expresses why you are well suited for a position in the specialty of your choice.

Preparing for Residency Interviews

Since the majority of residency programs receive many more applications than they have interview slots, receiving an invitation to interview means that you have survived the first round of eliminations.

You Have A Residency Interview. Now What?

Learn as much as you can about the program so that you arrive prepared to ask thoughtful and specific questions. This demonstrates your interest and helps you evaluate one program against another once you’ve completed all your interviews. You’ll receive information from the program; but you should also look at the electronic residency database (FRIEDA) and any websites for the program or its affiliated hospitals.

How Are Residency Interviews Used?

Residency programs use the interview process as a way to get to know you firsthand rather than through written materials. They are interested in your motivation for medicine and for their specialty, in your communication skills and personality, in your self-confidence and your ability to handle the interview. They hope to glean insights about your level of determination, reliability, integrity, and how you might respond to criticisms and the stresses of training. They also try to weigh how you might fit in with their current residents and staff. For IMG candidates, they are especially interested in your English language skills and your understanding of the residency training process.

How to Choose a Medical Specialty

Many students feel that the decision about specialty choice is one they are forced to make too soon and on too little information. So, how do you evaluate specialties and determine which is the right fit for you?

Research Your Medical Specialty Options

Most specialties’ websites are valuable sources of information about manpower trends, specialty board information and medical issues related to the specialty. Many also provide information about residency programs or provide a list of links to residency training programs.

Talk to People

Current residents are great sources for information about what training is really like. Physicians currently practicing in the specialty can also be helpful, particularly if they are willing to put you in touch with colleagues who help train residents.

Assess Your Own Competitiveness for the Specialty

An honest review of your academic performance in medical school, licensing exam scores and clinically related credentials is critical to making a decision about specialty choice. Specialties that are very popular will be harder to get into, and residency programs in desirable locations will be competitive even in the less sought-after specialties.

While it’s important to go after a position in a field you really want, it is also important to be realistic in assessing how you will match up against others who will be applying for positions in the same field or program. This is especially true for International Medical Graduates. Ultimately, you may have to make some compromises based on an ordering of the factors that are most important to you. Seek out individuals who can assess your credentials and give you honest feedback about your competitiveness as a residency applicant (medical school deans, residency program staff, current residents).

What Will Your Daily Routine Be?

Each specialty has a unique set of demands and challenges. You might find it helpful to make a list of the things you want to do, such as using medical technology, hands-on procedures, patient education and counseling, dealing with patients over a long span of time, etc. Compare your list to the descriptions of the specialties to see what fields best overlap your list. You may find that a specialty you never considered offers more of what you want to do daily than the specialties you were initially inclined to pursue. Consider the employment trends for the specialty. Will the US need more or fewer doctors in the field five or ten years out? This will impact your satisfaction level down the road.

Beginning Your ECFMG Application

IMGs: Get a head start on your pathway to residency. Check out this video and find out how to begin your ECFMG application.